Cyst

Dr. Subhayan Das

What is Cyst?
• It is a blind sac-like structure.
• Typically filled with liquid, semi-solid, or gaseous material.
• It can form in any part of the body, including the skin, organs, and
tissues.
• Cysts can be caused by infections, blockages of ducts, chronic
inflammatory conditions, or even genetic conditions.
• Some cysts are harmless (benign), while others may require
treatment if they become large, painful, or infected.
 What is Pseudocyst?
• A fluid-filled sac that resembles a cyst but lacks a true
epithelial lining.
Instead, it's surrounded by fibrous or granulation tissue, not by
epithelial cells like a true cyst.
Feature Description

Lining No epithelial lining (that's why it's "pseudo")

Wall Formed by fibrous tissue or inflammatory cells

Contents Fluid, enzymes, pus, necrotic debris, etc.

Cause Often due to trauma, infection, or inflammation

Common Sites - Pancreas (pancreatic pseudocyst)

What is Cul-de-Sac?
• Cul-de-sac refers to a blind pouch or a closed-end cavity in the
body, especially in the pelvic region.
• It’s a space where fluid or other materials can collect.

• Example:
• Rectouterine Pouch (Pouch of Douglas)
• Vesicouterine Pouch
 Based on Origin

Type Description Examples

Present from birth due to Dermoid cyst,
Congenital Cysts
developmental errors bronchogenic cyst
Develop later in life due
Ovarian cyst, sebaceous
Acquired Cysts to trauma, blockage,
cyst
infection
Based on Location
Location Common Cysts Found There
Skin Epidermoid, sebaceous cyst
Ovaries Follicular cyst, corpus luteum cyst
Kidneys Simple renal cyst, polycystic kidney
Liver Bile duct cyst, hydatid cyst
Breast Fibrocystic changes
Brain Arachnoid cyst, colloid cyst
Oral cavity Mucocele, ranula
Based on Contents

Type Contents Examples

Serous Cyst Clear fluid Serous ovarian cyst
Mucous Cyst Thick, sticky mucin Mucocele (oral cavity)
Sebaceous Cyst Oily, cheesy material Epidermoid cyst
Hemorrhagic ovarian
Hemorrhagic Cyst Blood-filled
cyst
Hydatid cyst
Parasitic Cyst Parasitic material
(Echinococcus)
 Based on Cause

Cause Example
Retention cysts (sebaceous,
Obstruction
mucous)
Hydatid cyst (parasitic),
Infection
abscess-like cysts
Cystic tumors (teratoma,
Neoplastic
cystadenoma)
Trauma Traumatic bone cyst
Inflammation Pseudocysts after pancreatitis
Clinical examination of Cyst
• Inspection
• Palpation
• Temperature
• Tenderness
• Consistency
• Surface
• Borders
• Mobility
• Compressibility
• Special Tests
Special Tests
• Transillumination: Helps differentiate cyst from solid mass.
• Fluctuation test: Positive in fluid-filled cysts (compress one side,
fluid moves to the other).
• Slip sign: In epidermoid (sebaceous) cyst: it slips away under
finger pressure.
• Ultrasound
• FNAC
Differential Diagnosis to Consider
• Lipoma (soft, not fluctuant, doesn't transilluminate)

• Abscess (tender, warm, may show systemic signs)

• Solid tumor (firm, non-fluctuant, doesn't transilluminate)

• Hematoma (history of trauma, blood-filled)

Dermoid Cyst
• Origin: Congenital inclusion of ectodermal elements during
development.
• Contents: Can contain hair, skin, sebum, teeth, cartilage.
• Appearance: Firm, mobile, slow-growing, non-tender.
• Present from birth or early childhood.
• Common Sites: Face (near eyes), midline scalp, neck, nasal
bridge.
• Treatment: Surgical removal, often done early in life.
Epidermoid Cyst (formerly called sebaceous
cyst)
• Origin: Arises from the epidermis or upper hair follicle.
• Contents: Filled with keratin, not sebum.
• Appearance:
• Round, dome-shaped, soft to firm.
• Central punctum (small black dot, clogged pore).
• May release a cheesy, foul-smelling material if ruptured.
• Common Sites: Face, neck, back, chest, scrotum.
• Treatment:
• Excision (complete removal including the wall to prevent recurrence).
• Incision & drainage if infected.
Ganglion Cyst
• Cause: Mucin-filled outpouching of joint or tendon sheath
• Location: Dorsal wrist is most common
• Features: Round, firm, may be tender; changes in size with
activity
• Treatment:
• Observation (often resolves)
• Aspiration
• Surgical excision if recurrent or painful
Hydatid Cyst
• Cause: Parasitic infection (Echinococcus granulosus)
• Common Sites: Liver > lungs > other organs
• Symptoms: Mass effect, rupture can cause anaphylaxis
• Imaging:
• “Honeycomb” or “daughter cyst” appearance on ultrasound
• “Water lily sign” in ruptured cysts
• Treatment:
• Albendazole (pre-op)
• Surgical excision with care to avoid rupture
• PAIR (Puncture, Aspirate, Inject, Reaspirate) for selected liver cases
Bartholin’s Cyst
• Cause: Blockage of Bartholin gland duct → fluid retention
• Symptoms: Swelling at posterior vulva, pain during
walking/sitting/intercourse
• Infected form: Bartholin abscess (tender, warm, red)
• Treatment:
• Word catheter placement (for drainage)
• Marsupialization (permanent opening)
• Antibiotics if infected
Renal Cysts

Type Features Notes

Asymptomatic, seen in
Simple cyst Benign, fluid-filled, cortical
>50% adults over 50
Bilateral enlarged kidneys,
Polycystic Kidney Genetic (ADPKD most
hypertension, hematuria,
Disease (PKD) common)
renal failure
Parapelvic cysts Near renal pelvis Can mimic hydronephrosis
Bone Cysts

Type Features Notes

Simple/Unicameral Fluid-filled, metaphyseal, May cause pathological
bone cyst often in humerus/femur fractures in kids
Blood-filled spaces,
Can be expansile and
Aneurysmal bone cyst painful swelling, often in
locally destructive
spine or long bones
Ovarian Cysts

Type Features Notes

Follicular (developing follicle
fails to rupture); Corpus Most common, often resolve
Functional cysts
luteum (remains post- spontaneously
ovulation)
“Chocolate cyst” filled with Related to endometriosis,
Endometrioma
old blood causes pelvic pain, infertility
Dermoid cyst (Mature Contains hair, fat, Benign but may twist
teratoma) sometimes teeth (torsion)
Seen in PCOS with hormonal
Polycystic ovaries Multiple small follicles
imbalance
Paronychia
Dr. Subhayan Das
What is it?
• Paronychia is an infection or inflammation of the skin around the
nails, specifically the lateral or proximal nail fold.
• It can be acute (sudden onset) or chronic (long-lasting)
• is often triggered by injury or irritation of the skin around the nail.
Etiology &
Risk Factors
• Nail-biting or picking
• Manicure trauma
• Ingrown nails
• Frequent wet work (e.g.,
dishwashing, healthcare
workers)
• Diabetes
• Immunosuppression
Acute Paronychia
• Rapid onset of:
• Redness, warmth, pain, and swelling of nail fold
• Pus formation or abscess
• May follow trauma or nail manipulation
Chronic Paronychia
• Persistent swelling, redness
• Nail changes: ridging, discoloration, detachment
• May affect multiple fingers
• Cuticle may be lost
Foreign Body
Dr. Subhayan Das
Skin and Soft Tissue Foreign Bodies
• Examples: Splinters, thorns, glass shards, metal fragments.
• Removal:
• Use sterilized forceps or a needle for superficial FBs.
• For deeper or embedded objects, perform minor surgical
exploration under local anesthesia.
• Imaging (X-ray or ultrasound) may be required to locate non-
visible FBs.
• Note: Always clean the wound, consider tetanus prophylaxis, and
check for signs of infection or retained fragments.
Eye Foreign Bodies (Superficial)
• Examples: Dust particles, metal flakes, eyelashes.
• Removal:
• Irrigate with sterile saline or remove gently using a moistened
cotton swab under slit-lamp examination.
• Topical anesthetic may be applied first.
• Note: Refer to an ophthalmologist if the FB is embedded, central
corneal, or if there’s suspicion of globe penetration.
Ear Foreign Bodies
• Examples: Beads, cotton, paper bits, insects.
• Removal:
• Use ear suction, alligator forceps, or a blunt ear hook.
• If it’s an insect, paralyze it first with mineral oil before removal.
• Note: Do not irrigate if the object is organic (e.g., seeds), as it may
swell and worsen obstruction.
Nasal Foreign Bodies
• Examples: Small toys, beads, bits of food or paper.
• Removal:
• Parent-assisted "blow technique" (also called the mother’s kiss),
use suction/forceps if accessible.
• Note: Common in children. Beware of unilateral foul-smelling
discharge—classic for retained nasal FB.
Throat / Oropharyngeal Foreign Bodies
• Examples: Fish bones, coins, chicken bones.
• Removal:
• Visible objects may be removed with forceps under good lighting.
• Refer for endoscopy if deep or not visualized.
• Note:
• Avoid blind removal attempts.
• X-ray or flexible scope may be needed.
Airway Foreign Bodies
• Examples: Food particles (e.g., peanuts), small toys.
• Removal:
• Emergency! Perform Heimlich maneuver if obstructed, followed
by bronchoscopy under anesthesia.
• Note:
• Classic signs include sudden coughing, wheezing, and decreased
breath sounds.
• Needs urgent airway management.
 Heimlich maneuver
• Ask if they are choking.“Are you choking?”
• If the person can talk or cough forcefully, do not
interfere.
• If they cannot respond or cough effectively →
proceed.
• Stand behind them.
• Wrap your arms around their waist.
• Make a fist.
• Place the thumb side of your fist just above the
navel and below the ribcage (on the upper
abdomen).Grasp your fist.
• With your other hand, hold your fist tightly.
• Perform quick upward thrusts.
• Press forcefully inward and upward, as if trying to
lift the person off the ground.
• Repeat until the object is expelled or the person
becomes unconscious.
For Infants (Under 1 Year Old)
• Do not perform abdominal thrusts.
• Use 5 back blows (on infant's back with head lower than chest)
• Followed by 5 chest thrusts (two fingers on breastbone)
• Alternate until object is expelled or help arrives
Important Notes
• Never use Heimlich on someone who can cough, speak, or
breathe.
• Use chest thrusts (instead of abdominal) in:
• Pregnant individuals
• Obese individuals
• After successful removal, seek medical evaluation, especially if
they were unconscious or had prolonged choking.
Gastrointestinal Foreign Bodies (Ingested)
• Examples: Coins, batteries, sharp objects, magnets.
• Removal:
• Coins often pass without issue—observe if asymptomatic.
• Batteries or magnets require urgent endoscopic removal due to risk of
tissue necrosis or perforation.
• Note: Sharp objects and multiple magnets are high-risk and must
be addressed quickly.
Thank You